Cost-effectiveness of laparoscopic disease assessment in patients with newly diagnosed advanced ovarian cancer

• Published in: Gynecologic oncology Vol. 161; no. 1; pp. 56 - 62
• Main Authors: Harrison, Ross F., Cantor, Scott B., Sun, Charlotte C., Villanueva, Mariana, Westin, Shannon N., Fleming, Nicole D., Toumazis, Iakovos, Sood, Anil K., Lu, Karen H., Meyer, Larissa A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2021
• Subjects: Cost-Benefit Analysis; Cost-effectiveness; Cytoreduction Surgical Procedures - economics; Cytoreduction Surgical Procedures - methods; Female; Humans; Laparoscopy - economics; Laparoscopy - methods; Minimally invasive surgery; Models, Economic; Models, Statistical; Ovarian cancer; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - economics; Ovarian Neoplasms - surgery; United States; United States; Cost-effectiveness; Minimally invasive surgery; Ovarian cancer
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2021.01.024

To determine if laparoscopy is a cost-effective way to assess disease resectability in patients with newly diagnosed advanced ovarian cancer. A cost-effectiveness analysis from a health care payer perspective was performed comparing two strategies: (1) a standard evaluation strategy, where a conventional approach to treatment planning was used to assign patients to either primary cytoreduction (PCS) or neoadjuvant chemotherapy with interval cytoreduction (NACT), and (2) a laparoscopy strategy, where patients considered candidates for PCS would undergo laparoscopy to triage between PCS or NACT based on the laparoscopy-predicted likelihood of complete gross resection. A microsimulation model was developed that included diagnostic work-up, surgical and adjuvant treatment, perioperative complications, and progression-free survival (PFS). Model parameters were derived from the literature and our published data. Effectiveness was defined in quality-adjusted PFS years. Results were tested with deterministic and probabilistic sensitivity analysis (PSA). The willingness-to-pay (WTP) threshold was set at $50,000 per year of quality-adjusted PFS. The laparoscopy strategy led to additional costs (average additional cost $7034) but was also more effective (average 4.1 months of additional quality-adjusted PFS). The incremental cost-effectiveness ratio (ICER) of laparoscopy was $20,376 per additional year of quality-adjusted PFS. The laparoscopy strategy remained cost-effective even as the cost added by laparoscopy increased. The benefit of laparoscopy was influenced by mitigation of serious complications and their associated costs. The laparoscopy strategy was cost-effective across a range of WTP thresholds. Performing laparoscopy is a cost-effective way to improve primary treatment planning for patients with untreated advanced ovarian cancer. •Laparoscopy is a cost-effective way to assess disease resectability in patients with newly-diagnosed advanced ovarian cancer.•Laparoscopy was cost-effective even when varying model parameters, such as the cost added by performing laparoscopy.•Laparoscopy is a valuable tool to improve treatment selection in untreated patients with advanced ovarian cancer.